Impact of young age on outcomes of emergency department procedural sedation.


Collaborators: Johnson DW(4), Farion KJ(5), Ali S(6), Beno S(7), Dixon A(6), McTimoney CM(4), Travassos G(4), McGahern C(8), Cantor Z(8), Fitzpatrick E(9), Dow N(6), Naranian T(7), Allard G(10).
Author information:
(1)Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario K1H 8L1, Canada. Electronic address: [Email]
(2)Department of Pediatrics, University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, USA. Electronic address: [Email]
(3)Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario K1H 8L1, Canada. Electronic address: [Email]
(4)Alberta Children's Hospital, Canada.
(5)CHEO, Canada.
(6)Stollery Children's Hospital, Canada.
(7)Hospital for Sick Children, Canada.
(8)Children's Hospital of Eastern Ontario, Canada.
(9)IWK Health Centre, Canada.
(10)Montreal Children's Hospital, Canada.


OBJECTIVES: Relatively little is known about outcomes of procedural sedation in very young children. Our objective was to examine the association between procedural sedation in young children (≤ 2 years) and the incidence of sedation-related adverse events. METHODS: This is a secondary analysis of a prospective cohort study of children 0 to 18 years undergoing parenteral procedural sedation in six Canadian pediatric emergency departments (ED). The primary risk factor was age ≤ 2 years. Secondary risk factors were sex, procedure type, pre-procedure and sedation medications. The outcomes examined were: serious adverse events (SAE), significant interventions, oxygen desaturation and vomiting. RESULTS: Of the 6295 patients included, 946 (15%) were ≤2 years. Children 13-24 months comprised 90% of the young age group. Children ≤ 2 years were sedated most commonly for laceration repair (n = 450; 47.6%), while orthopedic reduction was most common in children > 2 (n = 3983; 74.5%). Ketamine was the most common medication in both groups, but was used more frequently in children ≤ 2 years (80.9% vs 58.9%; p < 0.001). There was no difference in the odds of SAE (OR 0.83, 95% Confidence Interval (CI) 0.4 to 1.9), significant intervention (OR 0.82, 95% CI 0.4 to 1.7) or oxygen desaturation (OR 0.95, 95% CI 0.7 to 1.3) between age groups, however children ≤ 2 years vomited less frequently (OR 0.24, 95% CI 0.1 to 0.6). CONCLUSIONS: Young age, specifically between 13 and 24 months, was not associated with a significant difference in the incidence of adverse events.

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